Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Respiratory Research
Published in: Respiratory Research 1/2017

Open Access 01-12-2017 | Research

[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis

Authors: Aurélien Justet, Astrid Laurent-Bellue, Gabriel Thabut, Arnaud Dieudonné, Marie-Pierre Debray, Raphael Borie, Michel Aubier, Rachida Lebtahi, Bruno Crestani

Published in: Respiratory Research | Issue 1/2017

Login to get access

Abstract

Background

Idiopathic pulmonary fibrosis (IPF) is a devastating disease characterized by an unpredictable course. Prognostic markers and disease activity markers are needed. The purpose of this single-center retrospective study was to evaluate the prognostic value of lung fluorodeoxyglucose ([18F]-FDG) uptake assessed by standardized uptake value (SUV), metabolic lung volume (MLV) and total lesion glycolysis (TLG) in patients with IPF.

Methods

We included 27 IPF patients (IPF group) and 15 patients with a gastrointestinal neuroendocrine tumor without thoracic involvement (control group). We quantified lung SUV mean and SUV max, MLV and TLG and assessed clinical data, high-resolution CT (HRCT) fibrosis and ground-glass score; lung function; gender, age, physiology (GAP) stage at inclusion and during follow-up; and survival.

Results

Lung SUV mean and SUV max were higher in IPF patients than controls (p <0.00001). For patients with IPF, SUV mean, SUV max, MLV and TLG were correlated with severity of lung involvement as measured by a decline in forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) and increased GAP score. In a univariate and in a multivariate Cox proportional-hazards model, risk of death was increased although not significantly with high SUV mean. On univariate analysis, risk of death was significantly associated with high TLG and MLV, which disappeared after adjustment functional variables or GAP index. Increased MLV and TLG were independent predictors of death or disease progression during the 12 months after PET scan completion (for every 100-point increase in TLG, hazard ratio [HR]: 1.11 (95% CI 1.06; 1.36), p = 0.003; for every 100-point increase in MLV, HR: 1.20 (1.04; 1.19), p = 0.002). On multivariable analysis including TLG or MLV with age, FVC, and DLCO or GAP index, TLG and MLV remained associated with progression-free survival (HR: 1.1 [1.03; 1.22], p = 0.01; and 1.13 [1.0; 1.2], p = 0.005).

Conclusion

FDG lung uptake may be a marker of IPF severity and predict progression-free survival for patients with IPF.
Literature
1.
Fernandez IE, Eickelberg O. New cellular and molecular mechanisms of lung injury and fibrosis in idiopathic pulmonary fibrosis. Lancet. 2012;380(9842):680–8.CrossRefPubMed
2.
Visscher DW, Myers JL. Histologic spectrum of idiopathic interstitial pneumonias. Proc Am Thorac Soc. 2006;3(4):322–9.CrossRefPubMed
3.
Flaherty KR, Mumford JA, Murray S, Kazerooni EA, Gross BH, Colby TV, et al. Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia. Am J Respir Crit Care Med. 2003;168(5):543–8.CrossRefPubMed
4.
Collard HR, King TE, Bartelson BB, Vourlekis JS, Schwarz MI, Brown KK. Changes in clinical and physiologic variables predict survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2003;168(5):538–42.CrossRefPubMed
5.
Flaherty KR, Andrei A-C, Murray S, Fraley C, Colby TV, Travis WD, et al. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med. 2006;174(7):803–9.CrossRefPubMedPubMedCentral
6.
Ley B, Ryerson CJ, Vittinghoff E, Ryu JH, Tomassetti S, Lee JS, et al. A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann Intern Med. 2012;156(10):684–91.CrossRefPubMed
7.
Vuga LJ, Tedrow JR, Pandit KV, Tan J, Kass DJ, Xue J, et al. C-X-C motif chemokine 13 (CXCL13) is a prognostic biomarker of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2014;189(8):966–74.CrossRefPubMedPubMedCentral
8.
Borensztajn K, Crestani B, Kolb M. Idiopathic pulmonary fibrosis: from epithelial injury to biomarkers—insights from the bench side. Respir Int Rev Thorac Dis. 2013;86(6):441–52.
9.
Jenkins RG, Simpson JK, Saini G, Bentley JH, Russell A-M, Braybrooke R, et al. Longitudinal change in collagen degradation biomarkers in idiopathic pulmonary fibrosis: an analysis from the prospective, multicentre PROFILE study. Lancet Respir Med. 2015;3(6):462–72.
10.
Xie N, Tan Z, Banerjee S, Cui H, Ge J, Liu R-M, et al. Glycolytic reprogramming in myofibroblast differentiation and Lung fibrosis. Am J Respir Crit Care Med. 2015;192(12):1462–74.CrossRefPubMedPubMedCentral
11.
Maher TM. Aerobic Glycolysis and the Warburg Effect. An Unexplored Realm in the Search for Fibrosis Therapies? Am J Respir Crit Care Med. 2015;192(12):1407–9.CrossRefPubMedPubMedCentral
12.
Kaminski N, Rosas IO. Gene expression profiling as a window into idiopathic pulmonary fibrosis pathogenesis: can we identify the right target genes? Proc Am Thorac Soc. 2006;3(4):339–44.CrossRefPubMedPubMedCentral
13.
Groves AM, Win T, Screaton NJ, Berovic M, Endozo R, Booth H, et al. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18 F-FDG PET/CT. J Nucl Med Off Publ Soc Nucl Med. 2009;50(4):538–45.
14.
Lee EYP, Wong CS, Fung SL, Yan PK, Ho JCM. SUV as an adjunct in evaluating disease activity in idiopathic pulmonary fibrosis—a pilot study. Nucl Med Commun. 2014;35(6):631–7.CrossRefPubMed
15.
Larson SM, Erdi Y, Akhurst T, Mazumdar M, Macapinlac HA, Finn RD, et al. Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using PET-FDG Imaging. The visual response score and the change in total lesion glycolysis. Clin Positron Imaging Off J Inst Clin PET. 1999;2(3):159–71.CrossRef
16.
Shady W, Kishore S, Gavane S, Do RK, Osborne JR, Ulaner GA, et al. Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after (90)Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0. Eur J Radiol. 2016;85(6):1224–31.CrossRefPubMed
17.
Ho K-C, Fang Y-HD, Chung H-W, Liu Y-C, Chang JW-C, Hou M-M, et al. TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib. Eur J Nucl Med Mol Imaging. 2016;43(12):2155–65.CrossRefPubMed
18.
Umeda Y, Demura Y, Morikawa M, Anzai M, Kadowaki M, Ameshima S, et al. Prognostic value of dual-time-point 18 F-FDG PET for idiopathic pulmonary fibrosis. J Nucl Med Off Publ Soc Nucl Med. 2015;56(12):1869–75.
19.
Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788–824.CrossRefPubMed
20.
Cottin V, Crestani B, Valeyre D, Wallaert B, Cadranel J, Dalphin JC, et al. French practical guidelines for the diagnosis and management of idiopathic pulmonary fibrosis. From the National Reference and the Competence centers for rare diseases and the Société de Pneumologie de Langue Française. Rev Mal Respir. 2013;30(10):879–902.CrossRefPubMed
21.
Kazerooni EA, Martinez FJ, Flint A, Jamadar DA, Gross BH, Spizarny DL, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring. AJR Am J Roentgenol. 1997;169(4):977–83.CrossRefPubMed
22.
Collard HR, Moore BB, Flaherty KR, Brown KK, Kaner RJ, King TE, et al. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007;176(7):636–43.CrossRefPubMedPubMedCentral
23.
Pak K, Cheon GJ, Nam H-Y, Kim S-J, Kang KW, Chung J-K, Kim EE, Lee DS. Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis. J Nucl Med. 2014;55(6):884–90. 
24.
Bondue B, Sherer F, Van Simaeys G, Doumont G, Egrise D, Yakoub Y, et al. PET/CT with 18 F-FDG- and 18 F-FBEM-labeled leukocytes for metabolic activity and leukocyte recruitment monitoring in a mouse model of pulmonary fibrosis. J Nucl Med Off Publ Soc Nucl Med. 2015;56(1):127–32.
25.
Nishimura G, Komatsu M, Hata M, Yabuki K, Taguchi T, Takahashi M, et al. Predictive markers, including total lesion glycolysis, for the response of lymph node(s) metastasis from head and neck squamous cell carcinoma treated by chemoradiotherapy. Int J Clin Oncol. 2016;21(2):224–30.CrossRefPubMed
26.
Win T, Lambrou T, Hutton BF, Kayani I, Screaton NJ, Porter JC, et al. 18 F-Fluorodeoxyglucose positron emission tomography pulmonary imaging in idiopathic pulmonary fibrosis is reproducible: implications for future clinical trials. Eur J Nucl Med Mol Imaging. 2012;39(3):521–8.CrossRefPubMed
27.
Mura M, Belmonte G, Fanti S, Contini P, Pacilli AMG, Fasano L, et al. Inflammatory activity is still present in the advanced stages of idiopathic pulmonary fibrosis. Respirol Carlton Vic. 2005;10(5):609–14.CrossRef
28.
Lebtahi R, Moreau S, Marchand-Adam S, Debray M-P, Brauner M, Soler P, et al. Increased uptake of 111In-octreotide in idiopathic pulmonary fibrosis. J Nucl Med Off Publ Soc Nucl Med. 2006;47(8):1281–7.
29.
Busk M, Horsman MR, Kristjansen PEG, van der Kogel AJ, Bussink J, Overgaard J. Aerobic glycolysis in cancers: implications for the usability of oxygen-responsive genes and fluorodeoxyglucose-PET as markers of tissue hypoxia. Int J Cancer. 2008;122(12):2726–34.CrossRefPubMed
30.
Mamchaoui K, Makhloufi Y, Saumon G. Glucose transporter gene expression in freshly isolated and cultured rat pneumocytes. Acta Physiol Scand. 2002;175(1):19–24.CrossRefPubMed
31.
Huang Y, Kempen MB, Munck AB, Swagemakers S, Driegen S, Mahavadi P, et al. Hypoxia-inducible factor 2α plays a critical role in the formation of alveoli and surfactant. Am J Respir Cell Mol Biol. 2012;46(2):224–32.CrossRefPubMed
32.
Isobe K, Hata Y, Sugino K, Takai Y, Shibuya K, Homma S. Usefulness of FDG-PET for diagnosis of lung cancer associated with interstitial pneumonia. Nihon Kokyūki Gakkai Zasshi J Jpn Respir Soc. 2009;47(4):278–85.
33.
Pezzulo AA, Gutiérrez J, Duschner KS, McConnell KS, Taft PJ, Ernst SE, et al. Glucose depletion in the airway surface liquid is essential for sterility of the airways. PLoS One. 2011;6(1):e16166.CrossRefPubMedPubMedCentral
34.
Cho SJ, Moon J-S, Lee C-M, Choi AMK, Stout-Delgado HW. GLUT-1-Dependent Glycolysis is Increased During Aging-related Lung Fibrosis and Phloretin Inhibits Lung Fibrosis. Am J Respir Cell Mol Biol. 2016.
35.
El-Chemaly S, Malide D, Yao J, Nathan SD, Rosas IO, Gahl WA, et al. Glucose transporter-1 distribution in fibrotic lung disease: association with [18F]-2-fluoro-2-deoxyglucose-PET scan uptake, inflammation, and neovascularization. Chest. 2013;143(6):1685–91.CrossRefPubMed
Metadata
Title
[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis
Authors
Aurélien Justet
Astrid Laurent-Bellue
Gabriel Thabut
Arnaud Dieudonné
Marie-Pierre Debray
Raphael Borie
Michel Aubier
Rachida Lebtahi
Bruno Crestani
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2017
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-017-0556-3

Other articles of this Issue 1/2017

Respiratory Research 1/2017 Go to the issue

Research

The effect of glycopyrronium and indacaterol, as monotherapy and in combination, on the methacholine dose-response curve of mild asthmatics: a randomized three-way crossover study

Research

A role for B cells in organic dust induced lung inflammation

Research

Subtypes of asthma based on asthma control and severity: a latent class analysis

Research

Densitometric and local histogram based analysis of computed tomography images in patients with idiopathic pulmonary fibrosis

Research

A 3D epithelial–mesenchymal co-culture model of human bronchial tissue recapitulates multiple features of airway tissue remodeling by TGF-β1 treatment

Research

ABCB1 and ABCG2 drug transporters are differentially expressed in non-small cell lung cancers (NSCLC) and expression is modified by cisplatin treatment via altered Wnt signaling

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits